甲状腺髓样癌20例临床分析

Clinical analysis of medullary thyroid carcinoma ：a report of 20 cases

目的 探讨甲状腺髓样癌临床特点、诊断要点及治疗原则.方法 回顾性分析2005年1月至2012年12月20例甲状腺髓样癌患者的临床资料,全组病例均经病理证实为甲状腺髓样癌,颈淋巴结转移9例,远处转移1例,总颈部淋巴结转移率达50％.20例均行手术治疗,至少行患侧腺叶及峡部切除16例,占80％ （16/20）,其中行甲状腺全切除9例.结果 术后常规监测血清降钙素,复发2例.术后随访17例,超过5年者9例,5年生存率达77.8％.结论 甲状腺髓样癌术前诊断困难,多数依赖组织病理学检查确诊,强调细针穿刺细胞学检查的重要性,治疗以根治性手术为主,术后监测降钙素能及早发现局部复发和转移.

Objective To investigate the clinicopathological features,diagnosis and treatment principles of medullary thyroid carcinoma（MTC）.Methods The clinical data of 20 patients with MTC from January 2005 to December 2012 were retrospectively reviewed.All cases were confirmed by pathology.The total cervical lymph node metastasis rate was 50％,including 9 cases with cervical lymph node metastasis and 1 case with distant metastasis.All 20 cases were treated with operation and 80％ patients（16/20） underwent lobectomy and isthmectomy at least,including 9 cases of total thyroidectomy.Results Postoperative serum calcitonin were monitored and the recurrence occurred in 2 cases.A total of 17 cases were followed up after the operation and 9 cases were followed up for more than 5 years.The 5-year survival rate reached 77.8％.Conclusion MTC is difficult to be diagnosed preoperatively and it＇s mainly based on the histopathological examination.The importance of preoperative fine-needle aspiration for cytology test should be emphasized.The radical operation is the predominant treatment and postoperative monitoring of calcitonin could reveal local recurrence and metastasis early.